Should Serial MRIs Be Part of Treatment for Sesamoid Injuries?

In my experience, there are so many reasons to get magnetic resonance imaging (MRI) images when you suspect a sesamoid fracture. I think it is important enough to have my patients self-pay if there are any issues with their health insurance. I always think of an MRI for sesamoid injuries as the first MRI; with another needed in 6 months if something is found positive. In the MRI shown here, the tibial sesamoid is white (signifying an inflammatory reaction) when it should be black on this T2 image. T2 imaging is hypersensitive for water (or inflammation) within structures when it should not be. All we know by this one image and no other information, is that something is going on, which can be healing. This bone edema will typically be very sore for a patient to walk on.
 
After getting my first MRI and finding a positive finding, I tell the patient that typically we will repeat this MRI in 6 months to check for progress. I hope to initiate various treatments to get the pain level between 0 and 2 on a visual analog scale and allow for healing to occur. There are times that the patient is doing so much better that another MRI is not done. There are also times that the injury is too bad, complete healing does not occur, and the patient will either have surgery, or I put them on a 2-year “wait and see” plan.
 
You always have to treat the patient and not the image. And, I always strive to make treatment changes when a supbar plateau occurs. Since this is a bone, and bone health is crucial, I also consider vitamin D levels and bone density testing if healing is not following an expected course.
 
Dr. Blake is in practice at the Center for Sports Medicine, which is affiliated with St. Francis Memorial Hospital in San Francisco. He is a past president of the American Academy of Podiatric Sports Medicine. Dr. Blake is the author of the recently published book, “The Inverted Orthotic Technique: A Process Of Foot Stabilization For Pronated Feet,” which is available at www.bookbaby.com. 

Editor’s note: This blog originally appeared at www.drblakeshealingsole.com. It is adapted with permission from the author.

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